Glomerulonephritis with Crescents in Children: Etiology and Predictors of Renal Outcome

K Alsaad,A Al Ameer,A Al Sayyari,N Oudah,K Fakeeh,A Al Jomaih

doi:10.5402/2011/507298

K Alsaad, A Al Ameer + Show 4 more

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https://doi.org/10.5402/2011/507298

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Abstract

Objective. To investigate the clinicopathological features and outcome of glomerulonephritis with crescents among Saudi children. Method. This is a retrospective study of cases of crescentic glomerulonephritis (CrGN) seen over a 9-year period. Histological features and renal function were recorded. Results. Thirty-seven cases were enrolled. The mean percent of glomeruli with crescents was 39% (±19). Lupus nephritis (LN) was the commonest etiology (54.1%). At presentation, the serum creatinine (SCr) was 218.2 (±174.3) umol/l, and 57.1% of the cases had nephrotic range proteinuria. By the end of the observation period, SCr dropped to 81.0 (±67.7) umol/l (P = 0.001). Worsening renal function was associated with younger age (P = 0.002), non-LN etiology (P = 0.01), more crescents (P = 0.019), and ATN (P = 0.05). At the end of the followup, more patients in the LN group were dialysis-free (P = 0.017) and had improved renal function (0.01) than in the non-LN group. Using multivariate analysis, the only independent factor found to predict need for dialysis or change in SCr level was percent of globally sclerosed glomeruli (P = 0.034). Conclusion. LN is the main cause of CrGN in our cohort of children. The LN group had less globally sclerorsed glomeruli and better renal prognosis than the non-LN group.

Highlights

Of all renal biopsies done in the pediatric population, 5% to 15% are due to crescentic glomerulonephritis [1, 2]
There were no significant differences between the lupus nephritis and nonlupus nephritis groups in the prevalences of acute renal failure or proteinuria
One of the most striking differences we noted from other reports is in the etiology of crescentic glomerulonephritis

Summary

Introduction

Of all renal biopsies done in the pediatric population, 5% to 15% are due to crescentic glomerulonephritis [1, 2]. This variation in frequency is most likely due to differences in the indication criteria. The criteria for the number of affected glomeruli required for the diagnosis of crescentic glomerulonephritis vary from 20 to 75% in various pediatric studies [3]. The reports on crescentic glomerulonephritis in children are very few and most of these reports are over a decade old [2, 4,5,6]. Most of these reports suggest that the comments cause for crescentic glomerulonephritis in children is postinfectious glomerulonephritis and that the prognosis is generally poor

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